chapter 14: Autonomic Nervous System

Question 1

Charlie is a 65-year-old male who has been diagnosed with hypertension and benign prostatic hyperplasia. Doxazosin has been chosen to treat his hypertension because it:
A. Increases peripheral vasoconstriction
B. Decreases detrusor muscle contractility
C. Lowers supine blood pressure more than standing pressure
D. Relaxes smooth muscle in the bladder neck

Answer 1

D. Relaxes smooth muscle in the bladder neck

Question 2

To reduce potential adverse effects, patients taking a peripherally acting alpha1 antagonist should do all of the following EXCEPT:
A. Take the dose at bedtime
B. Sit up slowly and dangle their feet before standing
C. Monitor their blood pressure and skip a dose if the pressure is less than 120/80
D. Weigh daily and report weight gain of greater than 2 pounds in one day

Answer 2

C. Monitor their blood pressure and skip a dose if the pressure is less than 120/80

Question 3

John has clonidine, a centrally acting adrenergic blocker, prescribed for his hypertension. He should:
A. Not miss a dose or stop taking the drug because of potential rebound hypertension
B. Increase fiber in the diet to treat any diar-rhea that may occur
C. Reduce fluid intake to less than 2 liters per day to prevent fluid retention
D. Avoid sitting for long periods, as this can lead to deep vein thrombosis

Answer 3

A. Not miss a dose or stop taking the drug because of potential rebound hypertension

Question 4

Clonidine has several off-label uses, including:
A.	Alcohol and nicotine withdrawal
B.	Post-herpetic neuralgia
C.	Both A and B
D.	Neither A nor B

Answer 4

C. Both A and B

Question 5

Jim is being treated for hypertension. Because he has a history of heart attack, the drug chosen is atenolol. Beta blockers treat hypertension by:
A. Increasing heart rate to improve cardiac output
B. Reducing vascular smooth muscle tone
C. Increasing aldosterone-mediated volume activity
D. Reducing aqueous humor production

Answer 5

B. Reducing vascular smooth muscle tone

Question 6

Which of the following adverse effects are less likely in a beta1-selective blocker?
A. Dysrhythmias
B. Impaired insulin release
C. Reflex orthostatic changes
D. Decreased triglycerides and cholesterol

Answer 6

B. Impaired insulin release

Question 7

Richard is 70 years old and has a history of cardiac dysrhythmias. He has been prescribed nadolol. You do his annual lab work and find a CrCl of 25 ml/min. What action should you take related to his nadolol?
A. Extend the dosage interval
B. Decrease the dose by 75%
C. Take no action since this value is expected in the older adult
D. Schedule a serum creatinine level to vali-date the CrCl value

Answer 7

A. Extend the dosage interval

Question 8

Beta blockers are the drugs of choice for exertional angina because they:
A. Improve myocardial oxygen supply by vasodilating the coronary arteries
B. Decrease myocardial oxygen demand by decreasing heart rate and vascular resistance
C. Both A and B
D. Neither A nor B

Answer 8

B. Decrease myocardial oxygen demand by decreasing heart rate and vascular resistance

Question 9

Adherence to beta blocker therapy may be affected by their:
A. Short half-lives requiring BID dosing
B. Tendency to elevate lipid levels
C. Effects on the male genitalia, which may produce impotence
D. None of the above

Answer 9

C. Effects on the male genitalia, which may produce impotence

Question 10

Beta blockers have favorable effects on survival and disease progression in heart failure. Treatmen should be initiated when the:
A. Symptoms are severe
B. Patient has not responded to other thera-pies
C. Patient has concurrent hypertension
D. As soon as LV dysfunction is diagnosed

Answer 10

D. As soon as LV dysfunction is diagnosed

Question 11

Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for serious consequences of rapid withdrawal are those with:
A.	Angina
B.	Coronary artery disease
C.	Both A and B
D.	Neither A nor B

Answer 11

C. Both A and B

Question 12

To prevent life-threatening events from rapid withdrawal of a beta blocker:
A. The dosage interval should be increased by 1 hour each day
B. An alpha blocker should be added to the treatment regimen before withdrawal
C. The dosage should be tapered over a period of weeks
D. The dosage should be decreased by one-half every 4 days

Answer 12

D. The dosage should be decreased by one-half every 4 days

Question 13

Beta blockers are prescribed for diabetics with caution because of their ability to produce hypo-glycemia and block the common symptoms of it. Which of the following symptoms of hypogly-cemia is not blocked by these drugs and so can be used to warn diabetics of possible decreased blood glucose?
A.	Dizziness
B.	Increased heart rate
C.	Nervousness and shakiness
D.	Diaphoresis

Answer 13

D. Diaphoresis

Question 14

Combined alpha-beta antagonists are used to reduce progression of heart failure because they:
A. Vasodilate the peripheral vasculature
B. Decrease cardiac output
C. Increase renal vascular resistance
D. Reduce atherosclerosis secondary to elevated serum lipoproteins

Answer 14

A. Vasodilate the peripheral vasculature

Question 15

Carvedilol is heavily metabolized by CYP2D6 and 2C9, resulting in drug interactions with which of the following drug classes?
A.	Histamine 2 blockers
B.	Quinolones
C.	Serotonin re-uptake inhibitors
D.	All of the above

Answer 15

D. All of the above

Question 16

Bethanechol:
A. Increases detrusor muscle tone to empty the bladder
B. Decreases gastric acid secretion to treat peptic ulcer disease
C. Stimulates voluntary muscle tone to improve strength
D. Reduces bronchial airway constriction to treat asthma

Answer 16

A. Increases detrusor muscle tone to empty the bladder

Question 17

Clinical dosing of this drug:
A. Begins at the highest effective dose to obtain a rapid response
B. Starts at 5 mg to 10 mg PO and is repeat-ed every hour until a satisfactory clinical response is achieved
C. Requires dosing only once daily
D. Is the same for both the oral and parenter-al route

Answer 17

B. Starts at 5 mg to 10 mg PO and is repeat-ed every hour until a satisfactory clinical response is achieved

Question 18

Patients are taught to avoid which drug due to its antimuscarinic effects?
A.	Levothyroxine
B.	Prilosec
C.	Dulcolax
D.	Diphenhydramine

Answer 18

D. Diphenhydramine

Question 19

Anticholinesterase inhibitors are used to treat:
A.	Peptic ulcer disease
B.	Myasthenia gravis
C.	Both A and B
D.	Neither A nor B

Answer 19

B. Myasthenia gravis

Question 20

Which of the following drugs used to treat Alzheimer’s disease is not an anticholinergic?
A.	Donepezil
B.	Memantine
C.	Rivastigmine
D.	Galantamine

Answer 20

B. Memantine

Question 21

Taking which drug with food maximizes it bioavailability?
A.	Donepezil
B.	Galantamine
C.	Rivastigmine
D.	Memantine

Answer 21

C. Rivastigmine

Question 22

Which of the following drugs should be used only when clearly needed in pregnant and breast-feeding women?
A.	Memantine
B.	Pyridostigmine
C.	Galantamine
D.	Rivastigmine

Answer 22

B. Pyridostigmine

Question 23

There is a narrow margin between first appearance of adverse reaction to AChE inhibitors and serious toxic effects. Adverse reactions that require immediate action include:
A.	Dizziness and headache
B.	Nausea
C.	Decreased salivation
D.	Fasciculations of voluntary muscles

Answer 23

D. Fasciculations of voluntary muscles

Question 24

Adherence is improved when a drug can be given once daily. Which of the following drugs can be given once daily?
A.	Tacrine
B.	Donepezil
C.	Memantine
D.	Pyridostigmine

Answer 24

B. Donepezil

Question 25

Nicotine has a variety of effects on nicotinic receptors throughout the body. Which of the fol-lowing is NOT an effect of nicotine?
A. Vasodilation and decreased heart rate
B. Increased secretion of gastric acid and motility of the GI smooth muscle
C. Release of dopamine at the pleasure center
D. Stimulation of the locus ceruleus

Answer 25

A. Vasodilation and decreased heart rate

Question 26

Nicotine gum products are:
A. Chewed to release the nicotine and then swallowed for a systemic effect
B. “Parked” in the buccal area of the mouth to produce a constant amount of nicotine release
C. Bound to exchange resins so the nicotine is only released during chewing
D. Approximately the same in nicotine content as smoking two cigarettes

Answer 26

C. Bound to exchange resins so the nicotine is only released during chewing

Question 27

Nicotine replacement therapy (NRT):
A. Is widely distributed in the body only when the gum products are used
B. Does not cross the placenta and so is safe for pregnant women
C. Delays healing of esophagitis and peptic ulcers
D. Has no drug interactions when a trans-dermal patch is used

Answer 27

C. Delays healing of esophagitis and peptic ulcers

Question 28

Success rates for smoking cessation using NRT:
A. Are about the same regardless of the method chosen
B. Vary from 40% to 50% at 12 months
C. Both A and B
D. Neither A nor B

Answer 28

B. Vary from 40% to 50% at 12 months

Question 29

Cholinergic blockers are used to:
A. Counteract the EPS effects of phenothiazines
B. Control tremor and relax smooth muscle in Parkinson’s disease
C. Inhibit the muscarinic action of ACh on bladder muscle
D. All of the above

Answer 29

D. All of the above

Question 30

Several classes of drugs have interactions with cholinergic blockers. Which of the following is true about these interactions?
A. Drugs with a narrow therapeutic range given orally may not stay in the GI tract long enough to produce an action.
B. Additive antimuscarinic effects may occur with antihistamines.
C. Cholinergic blockers may decrease the sedative effects of hypnotics.
D. Cholinergic blockers are contraindicated with antipsychotics.

Answer 30

B. Additive antimuscarinic effects may occur with antihistamines.

Question 31

Scopolamine can be used to prevent the nausea and vomiting associated with motion sickness. The patient is taught to:
A. Apply the transdermal disk at least 4 hours before the antiemetic effect is de-sired
B. Swallow the tablet 1 hour before traveling where motion sickness is possible
C. Place the tablet under the tongue and al-low it to dissolve
D. Change the transdermal disk daily for maximal effect

Answer 31

A. Apply the transdermal disk at least 4 hours before the antiemetic effect is de-sired

Question 32

Scopolamine can be used to prevent the nausea and vomiting associated with motion sickness. The patient is taught to:
A. Apply the transdermal disk at least 4 hours before the antiemetic effect is de-sired
B. Swallow the tablet 1 hour before traveling where motion sickness is possible
C. Place the tablet under the tongue and al-low it to dissolve
D. Change the transdermal disk daily for maximal effect

Answer 32

B. Swallow the tablet 1 hour before traveling where motion sickness is possible

Question 33

You are managing the care of a patient recently diagnosed with benign prostatic hyperplasia (BPH). He is taking tamsulosin but reports dizziness when standing abruptly. The best option for this patient is:

1. Continue the tamsulosin because the side effect will resolve with continued treatment.
2. Discontinue the tamsulosin and start doxazosin.
3. Have him double his fluid intake and stand more slowly.
4. Prescribe meclizine as needed for the dizziness.

Answer 33

2. Discontinue the tamsulosin and start doxazosin.

Question 34

You are treating a patient with a diagnosis of Alzheimer’s disease. The patient’s wife mentions difficulty with transportation to the clinic. Which medication is the best choice?

1. Donepezil
2. Tacrine
3. Doxazosin
4. Verapamil

Answer 34

1. Donepezil

Question 35

A patient presents with a complaint of dark stools and epigastric pain described as gnawing and burning. Which of the medications is the most likely cause?

1. Acetaminophen
2. Estradiol
3. Donepezil
4. Bethanechol

Answer 35

4. Bethanechol

Question 36

Your patient calls for an appointment before going on vacation. Which medication should you ensure he has an adequate supply of before leaving to avoid life-threatening complications?

1. Carvedilol
2. Donepezil
3. Bethanechol
4. Tacrine

Answer 36

1. Carvedilol

Question 37

Activation of central alpha2 receptors results in inhibition of cardioacceleration and ______________ centers in the brain.

1. Vasodilation
2. Vasoconstriction
3. Cardiovascular
4. Respiratory

Answer 37

2. Vasoconstriction